Novel Triple-Cuff versus Conventional Double-Cuff Double-Lumen Endobronchial Tube in Patients with Risk Factors for Tube Misdirection

Abstract

Purpose: Accurate positioning of the double-lumen endobronchial tube (DLT) is crucial for successful lung isolation during thoracic surgery. However, misdirection of the left-sided DLT into the right main bronchus frequently occurs in short, obese females with narrow airways. A novel triple-cuff DLT features an additional carinal cuff positioned on the right side of the tube, which differentiates it from conventional double-cuff DLTs. We hypothesized that inflating the carinal cuff would direct the bronchial tip of the triple-cuff DLT toward the left main bronchus, thereby reducing the likelihood of DLT misdirection when compared to the conventional double-cuff DLT. Materials and Methods: In this single-center, unblinded randomized controlled trial, short, obese females with narrow airways were randomly assigned to either the triple-cuff or double-cuff group (n=77 each) and were intubated with the respective DLTs. The DLT misdirection rate, adjustment depth for optimal positioning, intubation time, and the incidence of hypoxia, airway injury, and postoperative airway complications were assessed. Results: Data from 143 patients were analyzed. The triple-cuff group exhibited a lower DLT misdirection rate compared to the double-cuff group (15.3% vs. 46.5%, odds ratio 4.81, 95% confidence interval 2.18-10.64, p<0.001). Triple-cuff DLT was also associated with fewer adjustments, shorter intubation times, and lower incidences of hypoxia, airway injury, and sore throat than double-cuff DLT. Conclusion: Triple-cuff DLT was superior to conventional DLT in reducing DLT misdirection in short, obese females with narrow airways. Furthermore, it facilitated a faster intubation process and reduced airway complications, thereby enhancing patient safety.